Infectious Disease

Chart alert moderately increases syphilis screening during pregnancy

Source/Disclosures

sources:

Ortega M, et al. Prenatal syphilis screening trend after implementation of a best practice advisory for syphilis screening in a large public health obstetrical center in southeastern Texas. Presented at: ASM Microbe; June 15-19, 2023; Houston.

Disclosures:
Ortega reports no relevant financial disclosures.

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Key takeaways:

  • A hospital system in Texas attempted to increase screening for syphilis among pregnant people.
  • An advisory that interrupted the completion of a chart unless a test was ordered only moderately increased testing.

A Texas health system moderately increased adherence to syphilis testing among pregnant people by implementing a tool that interrupted the completion of a chart if a test was not ordered, according to findings presented at ASM Microbe.

The best practice advisory (BPA) “was inspired by the alarming increase in syphilis cases among pregnant women in Houston, Texas, since 2021,” Melania Ortega, BS, a third-year student at McGovern Medical School at UTHealth Houston, told Healio.

“Currently, fetal deaths linked to congenital syphilis have increased in Harris County by 250%,” Ortega said. “Because approximately 30% of congenital syphilis results from a lack of provider adherence to guidelines, the implementation of a BPA in the electronic medical record may be a convenient and effective way to help providers maintain the standard of care.”

Ortega and Irene A. Stafford, MD, MS, an associate professor of obstetrics, gynecology and reproductive sciences at McGovern Medical School, conducted a prospective cohort study of individuals seeking care in a large public health care system in southeastern Texas in December 2022.

The BPA that was implemented on Dec. 15, 2022, interrupted chart completion unless a syphilis screening order was placed at 28 weeks’ gestation, Ortega said. The researchers compared screening practices from before and after the initiation of the BPA until Dec. 31, 2022.

“Providers spend a lot of time using the electronic medical record throughout patient encounters,” Ortega said. “If circumstances permit and are applicable, it is expected that a suggestion for appropriate treatment be followed.”

Out of 308 deliveries in December of 2022, 137 occurred before the BPA and 171 occurred after the BPA. Before implementation of the BPA, 77% of pregnant patients were appropriately screened at 28 weeks’ gestation. Afterwards, the number of appropriately screened patients increased modestly to 79%.

Ortega was not surprised that the proportion of appropriately screened patients went up.

“Providers spend a lot of time using the electronic medical record throughout patient encounters,” Ortega said. “If circumstances permit and are applicable, it is expected that a suggestion for appropriate treatment be followed.”

“Nearly half of new cases of [sexually transmitted infections] are among people aged 15 to 24,” Ortega said. “While the goal of this research is to improve prenatal syphilis screening practices and reduce congenital syphilis, I hope this encourages providers to be conscientious of screening all patients for STIs, especially those at high risk. By following BPAs such as this one, providers can increase awareness and education regarding the prevalence of STIs in their communities and advocate for appropriate prevention, screening, and treatment.”

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